Wednesday, August 25, 2010

The New England Journal of Medicine is becoming a platform for woo

Some might argue it's just soft woo, but it's still woo. First there was Berman's promotional and unscientific article on acupuncture (see Orac's analysis here). Now, just a few weeks later, we are offered this “study” on the effects of Tai Chi in the treatment of fibromyalgia. Well, we know exercise helps patients with fibromyalgia. And, some compelling anecdotal experience suggests that, if started early in the course of the disease, it might mitigate the progressive spiral of polypharmacy and higher and higher doses of narcotics and all the bad consequences associated therewith. Since there are many different forms of exercise it makes sense to ask if some work better than others. So it's perfectly legitimate to compare specific forms of exercise. The problem with the NEJM study is that, because it studies not just a particular type of exercise but an entire package of Eastern woo it lacks scientific rigor. From the methods section of the paper it appears that the real woo behind Tai Chi was promoted to the study patients. Even worse, the paper and the accompanying editorial seem to be entirely uncritical, at least regarding the woo claims behind the treatment in question.

I use the weasel words appears and seem in the commentary above because I don't have access to the papers in their entirety. You see, recently my subscription to NEJM lapsed. Now that NEJM, like many journals preceding it, has become a platform not only for political propaganda but now for woo, I'm not sure I want to spend my own money or dip into my CME stipend to re-up. Fortunately Orac cited portions of the body of the paper which illustrate my concerns (my emphasis):

The tai chi intervention was described thusly:The tai chi intervention took place twice a week for 12 weeks, and each session lasted for 60 minutes. Classes were taught by a tai chi master with more than 20 years of teaching experience. In the first session, he explained the theory behind tai chi and its procedures and provided participants with printed materials on its principles and techniques. In subsequent sessions, participants practiced 10 forms from the classic Yang style of tai chi18 under his instruction. Each session included a warm-up and self-massage, followed by a review of principles, movements, breathing techniques, and relaxation in tai chi. Throughout the intervention period, participants were instructed to practice tai chi at home for at least 20 minutes each day. At the end of the 12-week intervention, participants were encouraged to maintain their tai chi practice, using an instructional DVD, up until the follow-up visit at 24 weeks.

The control intervention consisted of this:Our wellness education and stretching program similarly included 60-minute sessions held twice a week for 12 weeks.19 At each session, a variety of health professionals provided a 40-minute didactic lesson on a topic relating to fibromyalgia, including the diagnostic criteria; coping strategies and problem-solving techniques; diet and nutrition; sleep disorders and fibromyalgia; pain management, therapies, and medications; physical and mental health; exercise; and wellness and lifestyle management.20 For the final 20 minutes of each class, participants practiced stretching exercises supervised by the research staff. Stretches involved the upper body, trunk, and lower body and were held for 15 to 20 seconds.

The NEJM is a relative latecomer in the promotion of woo. I guess it shouldn't surprise me, since woo is metastasizing rapidly throughout mainstream medicine. If NEJM keeps this up it may soon earn a place alongside the BMJ on Steve Barrett's list of non-recommended publications.